Charlotte Amelia Ebner, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

069580 Issued in GA

Practice address

2878 Five Forks Trickum Rd
Lawrenceville, GA 30044-5896

Phone

(678) 344-8700

Fax

(678) 344-8600

NPI assigned

Jun 14, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: charlotte.ebner.1@14940.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Reagan Medical Center LLC

  • Family Medicine Physician
  • Suwanee, GA
  • NPI 1952316747
  Medicare reassignment
• Spartanburg Medical Center

  • Physical Medicine & Rehabilitation Physician
  • Spartanburg, SC
  • NPI 1942188875
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486080000000",
    "number": "1912228941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2878 FIVE FORKS TRICKUM ROAD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "30044",
            "telephone_number": "678-344-8700",
            "fax_number": "678-344-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2878 FIVE FORKS TRICKUM RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300445896",
            "telephone_number": "678-344-8700",
            "fax_number": "678-344-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBNER",
        "first_name": "CHARLOTTE",
        "middle_name": "AMELIA",
        "name_prefix": "Miss",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-14",
        "last_updated": "2017-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "069580",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "1390",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01117581",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013906",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Easy Life Medical Group
• Easycare Services and More LLC
• Easylife Medical Group LLC
• Eudora Ayi Ebirien-Agana
• Aimee Lynn Eblen, P.T.
• Ikechukwu P. Ebo, D.D.S., P.A.
• Sylvia Eboigbe
• Ebt Holdings of Georgia Incorporated
• Eca Optical, LLC
• Jonathan Alberto Echeverria, PHARMD

• Family Medicine Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.